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Department

Denver Health Medical Plan is not your ordinary health insurance carrier. Unlike regular insurance companies that operate to make a profit for their shareholders, we?re a local, nonprofit company that directs our funds toward the well-being of our members and making quality care accessible to all.

Since 1997, we?ve dedicated ourselves to serving the Denver metro community. Today, more than 100,000 members trust us with their health care needs. 

Job Summary

Assist the activity of the organization's actuarial and medical economics work. Work with external teams of actuaries and analysts to complete rate filings, analysis of the local healthcare landscape, help increase risk adjustment capture and aid product teams in benefit design analysis. Helps with coaching, training, and support to educate other departments when necessary. Works with the analytics team to ensure data accuracy for rate filings and has a firm understanding of healthcare data complexity. Keeps track of the regulatory environment across multiple product lines in conjunction with the product teams to ensure that elements that might affect pricing, network strategy, and risk adjustment are considered when filing rates. Works collaboratively with the other departments to achieve alignment between rate setting and risk adjustment initiatives. Suggests strategic initiatives to lower healthcare costs, maintain quality and generate risk adjustment opportunities.

Essential Functions:

• Lead the development of product pricing and reserves for various health insurance products. (20%)
• Conduct analysis and make recommendations on rate changes, product design, and medical management policies based on data-driven insights (20%)
• Review and analyze trends in healthcare utilization, cost, and quality to identify opportunities for cost containment through contracting or care management activities. (20%)
• Manage the budget and resources of the actuarial and medical economics teams to ensure efficient and effective operation. (20%)
• Collaborate with numerous departments to develop company-wide policies and procedures related to actuarial, medical economics and risk adjustment functions. (20%)

Education:

• Bachelor's Degree Bachelor?s degree in Economics, Statistics, Computer Science, Business, Public Health, Epidemiology, Mathematics, Risk Management, Actuarial Science, Data Analytics or related quantitative discipline required and
• ASA or FSA Actuarial designation required

Work Experience:

• 10+ years of progressive Health Insurance Experience (Medicaid, Medicare, ACA) required and
• 5 years of direct experience with both MA and ACA risk adjustment required

Licenses:
Knowledge, Skills and Abilities:

• Knowledge of health care administration, including managed care, Medicaid, Medicare, Exchange and CHP+.
• Knowledge of STARs and Risk Adjustment required.
• Skilled in analytical thinking, problem solving, and process improvement.
• Ability to grow and develop strong teams from scratch.
• Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion.

Shift

Work Type

Salary

Benefits

• Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans

• Free RTD EcoPass (public transportation)

• On-site employee fitness center and wellness classes

• Childcare discount programs & exclusive perks on large brands, travel, and more

• Tuition reimbursement & assistance

• Education & development opportunities including career pathways and coaching

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program 

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

Our Values

• Respect

• Belonging

• Accountability

• Transparency

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver?s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation.

As Colorado?s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.

Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).

Denver Health values the unique ideas, talents and contributions reflective of the needs of our community. For more about our commitment to diversity visit: https://www.denverhealth.org/for-professionals/careers/diversity-and-inclusion

Applicants will be considered until the position is filled.

About Denver Health

Take your career to the next level at Denver Health, where we offer a robust benefits package and endless opportunities for growth. Denver Health is a nationally-ranked, locally-trusted, premier healthcare institution located in the heart of Denver, Colorado.Twenty-five percent of all Denver residents, or approximately 150,000 individuals, receive their health care here. We are known as an integrated health care system that encompasses multidisciplinary academic specialties, a community health system, a level I adult trauma center, pediatric emergency and urgent care center home to Denver Public Health and many of the nation's leaders in medicine.Denver Health is an Equal Opportunity Employer At Denver Health we pride ourselves on our commitment to diversity. Equal opportunity is a fundamental principle of Denver Health. As an equal opportunity employer, Denver Health is committed to recruit, hire, promote and administer all human resource actions in a non-discriminatory manner. Denver Health is committed to providing equal opportunities in all business practices and to all persons regardless of age, race, color, national origin, genetic information, religion, sex, pregnancy, disab...ility, sexual orientation, gender identity, gender expression, marital status or veteran status (collectively “protected status”). Denver Health strives to maintain a work environment that is free from unlawful harassment and discrimination and will not tolerate any such conduct by employees or directed at employees within the scope of their employment. Read the full Human Resources Employee Principles and Practices policy.

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